The undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff.

Objective To investigate the self-reported confidence and preparedness of final year undergraduate students in undertaking a range of clinical procedures.Methods A questionnaire was distributed to final year dental students at Cardiff University, six months prior to graduation. Respondents rated their confidence in undertaking 39 clinical procedures using a 5-point scale (1 = can undertake on own with confidence, 5 = unable to undertake). Students also responded yes/no to experiencing four difficulties and to three statements about general preparedness.Results 71% (N = 51) responded of which 55% (N = 28) were female. Over half reported being 'anxious that the supervisor was not helping enough' (57%) and 'relying heavily on supervisor for help' (53%). Eighty percent 'felt unprepared for the clinical work presented' and gender differences were most notable here (male: 65% N = 33; females: 93% N = 47). Mean confidence scores were calculated for each clinical procedure (1 = lowest; 5 = highest). Confidence was highest in performing 'simple scale' and 'fissure sealant' (mean-score = 5). Lowest scores were reported for 'surgical extractions involving a flap (mean-score = 2.28)', 'simple surgical procedures' (mean-score = 2.58) and the 'design/fit/adjustment of orthodontic appliances' (mean-score = 2.88).Conclusions As expected complex procedures that were least practised scored the lowest in overall mean confidence. Gender differences were noted in self-reported confidence for carrying out treatment unsupervised and feeling unprepared for clinical work.

Communication and professionalism skills of a new graduate: the expectations and experiences of dental foundation trainers.

AIM: The aim of this study was to investigate dental foundation year 1 (DF1) trainers' expectations of the dental graduate specifically in relation to non-clinical (professionalism and communication) skills and to explore whether these expectations were being met. METHOD: In the UK, dental graduates undertake 1 year of foundation training prior to being permitted to undertake NHS practice. An online survey was distributed to DF1 trainers via all 11 English deaneries and the Northern Ireland deanery. Demographic information and a general view of trainers' expectations of a new trainee were collected. Specific questions relating to six generic trainee problems were followed by 11 ability statements where trainers indicated their expectation of a trainee's ability to perform the skill on a 5-point scale (on own with confidence-unable to undertake). Statements were repeated and trainers were required to respond using the same scale in relation to experience of their current trainee. RESULTS: Five hundred and ten (53%) trainers completed the questionnaire with no missing data. Expectations were high with almost 50% of trainers expecting a new graduate to manage a full list of patients on their own. Experience of new graduates did not always match these expectations. Of concern was the ability to 'keep accurate patient records' and 'self-reflection and knowing when to seek help', where a small proportion of trainers experienced difficulties. CONCLUSIONS: Trainers' expectation and experience in relation to non-clinical skills of a new graduate were investigated. Although they had high expectations, the majority reported only minor problems overall. There were a few areas where concern was raised.

Outreach training: the special interest group's report.

Following three sessions at ADEE Annual Meetings, the special interest group on outreach training presents a brief report of its proceedings. Outreach, here, is clinical teaching away from the home dental school. After covering the diversity and benefits of programmes, the report considers different models and the relationship between contexts and outcomes. It concludes that: outreach provides access to additional resources; programmes prepare students for the demands of the profession; a programme's design should harmonise with both its context and its objectives; and, the educational benefits warrant the additional organisation involved.

Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork.

AIM: The aim of this study was to describe the self-reported confidence levels of final year students at the School of Dentistry, Cardiff University and at the University Dental School & Hospital, Cork, Ireland in performing a variety of dental procedures commonly completed in primary dental care settings. METHOD: A questionnaire was distributed to 61 final year students at Cardiff and 34 final year students at Cork. Information requested related to the respondents confidence in performing a variety of routine clinical tasks, using a five-point scale (1=very little confidence, 5=very confident). Comparisons were made between the two schools, gender of the respondent, and whether or not a student intended completing a year of vocational training after graduation. RESULTS: A response rate of 74% was achieved (n=70). The greatest self-reported confidence scores were for 'scale and polish' (4.61), fissure sealants (4.54) and delivery of oral hygiene instruction (4.51). Areas with the least confidence were placement of stainless steel crowns (2.83), vital tooth bleaching (2.39) and surgical extractions (2.26). Students at Cardiff were more confident than those at Cork in performing simple extractions (Cardiff: 4.31; Cork: 3.76) and surgical extractions (Cardiff: 2.61; Cork: 1.88), whilst students in Cork were more confident in caries diagnosis (Cork: 4.24; Cardiff: 3.89) fissure sealing (Cork: 4.76; Cardiff: 4.33) and placement of preventive resin restorations (Cork: 4.68; Cardiff: 4.22). CONCLUSION: Final year students at Cardiff and Cork were most confident in simpler procedures and procedures in which they had had most clinical experience. They were least confident in more complex procedures and procedures in which they had the least clinical experience. Increased clinical time in complex procedures may help in increasing final year students' confidence in those areas.

Attitudes of final-year dental students to bleaching of vital and non-vital teeth in Cardiff, Cork, and Malmö.

The aim of this study was to determine attitudes of final-year dental students in Cardiff, Cork and Malmö towards tooth whitening. Following receipt of ethical approval, pre-piloted questionnaires were distributed to final-year dental students in Cork, Cardiff, and Malmö as close as possible to graduation. The questionnaire sought information relating to various opinions and attitudes towards the use of bleaching techniques including safety of bleaching, confidence in the provision of bleaching, recommendations to patients, teaching received, awareness of restrictions on the use of bleaching products and management of simulated clinical scenarios. Eighty three per cent (n = 116) of questionnaires were returned. Cork dental students had the most didactic teaching (2-h vital, 1-h non-vital bleaching) compared to Cardiff or Malmö students (0 h each). More Cork students regarded bleaching as safe (76%, n = 28) than Cardiff (70%, n = 32) or Malmö (36%, n = 12) students. More than 50% of Cork students feel they know enough about bleaching to provide it in practice, significantly more than Cardiff (< 25%) or Malmö (< 25%) students. The majority of students would provide vital bleaching after qualification (100% (n = 37) Cork; 82% (n = 27) Malmö; 76% (n = 35) Cardiff). In simulated clinical scenarios, more Cork students would propose bleaching treatments (89%n = 33) than Malmö (64%n = 21) or Cardiff (48%n= 22) students. Variations exist in the attitudes and approaches of three European dental schools towards bleaching. Dental students need to be best prepared to meet the needs of their future patients.

Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth.

The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmö: n=27). Ninety-three per cent of Malmö students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmö students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.

The teaching of fixed partial dentures in undergraduate dental schools in Ireland and the United Kingdom.

All areas of the practice of dentistry are evolving at a considerable pace. One area in particular which has seen a rapid revolution is the oral rehabilitation of partially dentate adults. The aim of this study was to describe the contemporary teaching of fixed partial dentures (FPDs) in dental schools in Ireland and the United Kingdom. An online questionnaire which sought information in relation to the current teaching of FPDs was developed and distributed to 15 Irish and UK dental schools with undergraduate teaching programmes in Spring 2009. Responses were received from 12 schools (response rate=80%). All schools offer teaching programmes in relation to FPDs. The number of hours devoted to pre-clinical/phantom head teaching of FPDs ranged from 3 to 42h (mean: 16h). The staff/student ratio for pre-clinical teaching courses in FPDs ranged from 1:6 to 1:18 (mode: 1:12). Cantilever resin-retained FPDs were the most popular type of FPD provided clinically (average=0·83 per school; range=1-2). Five schools (42%) report that they have requirements (e.g. targets, quotas, competencies) which students must complete prior to graduation in relation to FPDs. Fixed partial dentures form an important part of the undergraduate teaching programme in UK and Irish dental schools. While this teaching is subjected to contemporary pressures such as lack of curriculum time and a lack of available clinical facilities and teachers, there is evidence that teaching programmes in this area are evolving and are sensitive to current clinical practice trends and evidence-based practice.

Treatment planning for replacing missing teeth in UK general dental practice: current trends.

The aim of this study was to examine the confidence, barriers and attitudes towards the replacement of missing teeth by general dental practitioners (GDPs). The perceived impact of the recently introduced National Health Service (NHS) contract on the provision of prosthodontic treatments was also considered. Pre-piloted postal questionnaires were mailed to 500 GDPs in Wales. Open- and closed-ended questions were utilised to establish confidence, adequacy of training and attitudes towards treatments for replacing missing teeth. Two hundred and seventeen completed questionnaires were received (response rate = 43.4%). Many respondents described themselves as 'confident' or 'very confident' in the provision of removable partial dentures (RPDs) (acrylic = 100%, metal based = 99.5%), cantilever resin-bonded bridges (94.4%) and conventional bridgework (98.6%). GDPs were 'not confident' providing fixed-fixed resin-bonded bridges (21.1%) or implants (81.4%). Financial barriers were identified to the provision of prosthodontic treatments, including comments such as "the new [National Health Service] contract does limit the treatments available". Privately funded patients were more likely to be offered a fixed bridge or implant replacement of a missing upper first molar, whereas non-privately funded patients were more likely to be offered no treatment (P < 0.01). Most respondents reported confidence at providing more routine forms of prosthodontic care such as RPDs and bridges. It appears that funding arrangements may have an impact on treatments offered to replace missing teeth, particularly under the current NHS contract.

Quality of prescription and fabrication of single-unit crowns by general dental practitioners in Wales.

The aim of this investigation was to describe the quality of prescription and fabrication of single-unit crowns by general dental practitioners in Wales. One hundred pre-piloted questionnaires were distributed to commercial laboratories in Wales with large catchment areas, and 20 pre-piloted questionnaires were distributed to the production laboratory at the Cardiff Dental Hospital. Information was collected relating to the quality of prescription and master impressions for single-unit crowns. One hundred and seven completed questionnaires were returned (response rate = 89%). Sixty per cent (n = 64) of questionnaires related to single-unit crowns being made in general practice under private funding arrangements, 30% (n = 32) were being made in general dental practice under National Health Service (public) funding arrangements and 10% (n = 11) were collected from the Dental Hospital. Polyvinylsiloxane impression material was used to record the master impression in all cases (n = 107). Plastic stock trays were used to make the master impression in 79% of cases (n = 85), metal stock trays were used in 19% of cases (n = 20) and special trays were used in 2% of cases (n = 2). Eighty-five per cent (n = 91) of master casts were considered to be adequate for crown fabrication. Less than 50% of written instructions (n = 52) were considered 'clear' and of sufficient detail to adequately specify the planned crown. In 21% of cases (n = 22), the technician had to contact the dentist for clarification of the design prior to making the crown. While the quality of impression making for single-unit crowns was of a reasonable standard, the quality of the accompanying written communication was poor and more than one-half of written instructions examined failed to meet the requirements of the European Union Medical Devices Directive.

The teaching of implant dentistry in undergraduate dental schools in the United Kingdom and Ireland.

OBJECTIVES: The objective of this paper is to describe the contemporary teaching of dental implantology to dental undergraduates in the United Kingdom and Ireland. The paper also aims to assess the attitudes of dental school educators in relation to future trends in dental implant training for dental undergraduates. METHODS: An online questionnaire relating to current and future possible trends in dental implantology education was developed and distributed to Heads of Division/Departments of Restorative Dentistry, or equivalent, in each of the 15 dental schools with undergraduate dental programmes in the United Kingdom and Ireland. The questionnaire included both 'open' and 'closed' style questions. RESULTS: All 15 dental schools invited to participate in this survey responded. Of the 15 schools, two do not provide any training for their undergraduate dental students in relation to implant dentistry. The teaching is mainly delivered in lecture-based or phantom head room settings (eight of the 13 implant-teaching schools). Only four schools allow their students to interact clinically with implant patients. All schools anticipate an increase in dental implant teaching in the next five years, however, there is much variation in the scope and nature of this increase. CONCLUSIONS: The teaching of dental implants in the UK and Ireland has increased since the time of previous surveys. It would seem prudent for this theme of teaching to further increase in order to best prepare graduating students for independent clinical practice.

An in vitro study on the use of circumferential matrix bands in the placement of Class II amalgam restorations.

OBJECTIVE: To compare the effectiveness of a disposable metal matrix band system and the Siqveland matrix system in the restoration of a Class II preparation with amalgam. To assess the difference in amalgam overhang produced between the two systems in vitro. METHODS: A right maxillary first premolar with a Class II cavity preparation was duplicated in acrylic to produce a standardized cavity. Forty acrylic teeth were individually mounted in a hand-held model of an upper right quadrant and restored with amalgam by twenty dentists. Each dentist restored two replica teeth with amalgam; one using the Omni-matrix system and the other using the Siqveland matrix system. All 40 restored teeth were individually mounted on a standardised jig, viewed under a microscope, photographed and overhangs, if present, measured using Image ProPlus 4.0. A comparison of the overhangs produced by the two systems was analysed using a paired sample t-test. RESULTS: An overhang was present in all cases. There was a significant difference in the size of the overhangs produced by the two different matrix systems (p-value 0.036). The Siqveland produced a larger overhang than the Omni-matrix system. CONCLUSION: A commonly used matrix band (Siqveland), when compared to a newer, disposable system (Omni-matrix), was found to result in consistently larger overhangs during the restoration of class II preparations with amalgam. As Omni-matrix is a disposable system, the potential for cross-contamination is removed and it can, therefore, be considered a suitable replacement for the non-disposable Siqveland matrix system.

Radiographic evidence of postoperative healing 12 years following root canal treatment--a case report.

A case with evidence of radiographic healing of a periapical lesion 12 years after root canal treatment is presented. The use and limitations of previously produced guidelines on radiographic follow-up intervals are discussed. Questions are raised about what is known of the healing process and when further treatment should be instituted. The reliance on single radiographs alone when making treatment decisions is discouraged.

Attitudes of general dental practitioners in the UK to the use of composite materials in posterior teeth.

OBJECTIVE: To determine the opinions and current methods used in placing posterior composite restorations by general dental practitioners. SETTING: The study was completed by general dental practitioners randomly selected from across the UK. METHOD: A questionnaire was devised to gain this information. It was sent to 500 UK dentists chosen at random from the general dental register, with an explanatory letter and reply-paid envelope. RESULTS: Two hundred and sixty-seven replies were received. Sixty-one percent of dentists felt amalgam use had decreased over the last five years, 75% felt posterior composite use had increased. Regarding choice of posterior material, almost all cited clinical indication as the most influential factor while patient's aesthetic demands (89%),wish for a certain material (78%) and the dentist's confidence using a certain restorative material (76%) were contributing factors. Regarding the techniques used, contemporary techniques were employed although there was confusion regarding the need for rubber dam and the most appropriate method of lining the cavity. A case scenario of a pregnant patient who required treatment found that 66% of respondents would place a restoration other than a temporary dressing, with 16% placing an amalgam restoration. CONCLUSIONS: The majority of dentists surveyed place load bearing posterior composite restorations regularly. Their choice of restorative material is influenced by clinical indications and the patient's aesthetic demands. The techniques used were appropriate, although there was confusion around the need for rubber dam and the most appropriate method to line the cavity. There was also confusion in relation to the most appropriate materials for use in pregnancy.

Eye safety in operative dentistry - a study in general dental practice.

AIM: In this safety conscious age all general dental practitioners should be promoting the use of eye protection. The aim of this study was to highlight the uptake of eye protection by all clinical staff and patients within the general dental practice setting, with regard to adequate protection and its use at appropriate times. METHOD: Questionnaires were sent to 200 GDPs, chosen at random, to accumulate information on the use of protection, the preferred methods of eye protection and any experience of ocular injury. FINDINGS: Eighty-seven per cent of GDPs wore eye protection routinely, but their choice of protection was not always adequate and not worn for all procedures. Forty-eight per cent of GDPs had experience of ocular trauma or infection which occurred during a variety of procedures; 75% of these injuries resulted from not wearing eye protection. In contrast less than half of the DNs and Hygienists use protection routinely, particularly when cleaning contaminated instruments. However, hygienists did wear eye protection for the majority of their patient work (96%). CONCLUSION: Eye protection use by all staff and patients is currently suboptimal to conform to published guidelines. Risks encountered within the dental environment do cause harm to the unprotected eye, which can be reduced or even eliminated by improving the uptake of suitable eye protection; several choices for eye protection are available. Each individual dentist is responsible for the uptake of eye protection for all persons in their surgery environment.